Ask Polly

Stop Your Team From Giving Away The Farm!
by
“Do you have any idea what they’re saying out there?”. This always seems to be the first thing we say to clients after observing admission visits. It’s not that they aren’t trying to do a good job. It’s that we’ve trained them to describe a standard hospice benefit that may not be appropriate for the patient’s or family’s situation.

Dangerous expectations: If your nurses or reps are telling families that “the nurse visits 3-5 times a week, and the aide will be here for an hour and a half”, then they are setting expectations that may not apply.

Remember case management?: What if the patient only needs a visit every 2 weeks and has a network of family and friends who want to help him with daily needs? Should we be offering a level of care to this patient that may prevent us from providing more intensive care needs to an acutely ill patient with no caregiver?

Good News, Bad News: The good news is that hospice use will continue to grow. The bad news is that reimbursement will remain tight, as will the labor pool. So it’s up to us to increase care team capacity by making sure we work smarter, plan smarter, and don’t set inappropriate patient expectations!

Here are a few re-training ideas for your Program Reps, Liaisons, and Admissions Nurses:

-DESCRIBING THE BENEFIT - It’s okay to define team roles, but indicate that “the extent of their role will depend upon your needs and further discussion with the care team”. Don’t specify standard visit frequency or length, except when putting together the initial plan of care. Then indicate what it will be for the next few days only.

-DESCRIBING THE PROCESS - It is absolutely appropriate to indicate that the interface with different team members will be adjusted as the needs of the patient or family change.

-REMEMBER VOLUNTEERS? - It’s a tough situation when the family says, “well, he needs a lot of help,” or, “They said you’d be here everyday.” So, if they don’t have the resources for private care, and they need some additional help, tap into your volunteer pool! But again, don’t make any promises!

-REMEMBER PRIVATE DUTY AIDES? - If they do have the resources, recommend private duty help. A caveat: the labor shortage is a big problem here too, so offer the resource, but don’t promise the outcome!

A Little Night Magic
by

One of the great values that Hospice care offers to patients and caregivers is 24/7 availability (big deal. so does your primary care physician, and we all know how that works!). To the average consumer with no hospice experience, it can either be an empty promise ("yeah right, we’ve heard that before") or conjure up visions of such dreadful service as calling AOL with a technical problem and being on hold forever to get an answer.

WHY OUTSOURCE a key function like a 24/7 helpline to an answering service? Outsource your payroll or some other internal function that doesn’t touch the customer, but NOT YOUR FRONT LINE.

But how can you justify the cost? Here’s a number of services you might provide:

Call new admissions the day of admit: this is really a no brainer. The best service you can provide is one that’s proven before it’s ever needed

Demonstrate the power behind your promise by calling the patient or caregiver (or the unit staff at the nursing home) on the evening of admission

Here’s what to say:

“Hi, my name is Diane and I’m with Acme Hospice. I understand that you’re now a part of our service and I want to welcome you to the acme family of care. I’m one of the people you might be talking to some evening, so I wanted to introduce myself and let you know that we’re always here to help you anytime - night or day.”

Next time we’re going to talk about how to prioritize these calls, other uses for a 24/7 live person, and other benefits to having an actual live person available 24/7 on a helpline.

Asking For The Referral at Every Single Visit!
by

In order to increase referrals, you need to increase “top of mind” awareness among your referral sources. After all, they dont just sit around all day, twiddling their thumbs and thinking “who can I refer to hospice today?”

You need to ask. In order to have that consistent awareness by your referral sources, you need to ask the question at the end of every admission visit: “is there anyone else I can help you with today?”

It’s not automatic: as always, you’ve got to role play this with your teams so that it becomes and natural way to end a visit. The more they practice, the more it becomes second nature. The more it becomes second nature, the more you ensure that it happens on every. single. call.

For the Care Teams: This applies to them also. At the end of every facility visit, they need to ask the staff is there’s anyone else who they can help them with today.

Should be natural: Teach and practice having the team members ask in a manner that is consistent with their personality, sounds natural, and doesn’t make them feel slimy. The key is to make it easy for the staff member to try it out. Once they do, they will see success and will start to include it in more and more calls. Keeping it natural makes it easier to get them to their first attempt.

When Your Nursing Home Team Gets a Referral (part 1)
by

You may have your liaisons or marketing reps covering the nursing homes and providing in-services there, but who usually gets the referral? Your care team. They’re the ones who are there day in and day out, and the ones most readily approached by the staff.

Have you trained your care teams? Do they even know it’s a referral? Any question about criteria or appropriateness, or a tap on the shoulder with “I may have one but the family is really difficult” is a referral! Why do you think they’re asking the question, because they are curious or have nothing better to do?

They’re asking because they need your help! They may not use the term “referral” or “help” directly, but that’s exactly what they are doing when they approach your nurses. So it’s the care team member’s job to take the referral.

What usually happens is that your staff politely says “well, we’re always here to help, so just let us know”. Nice? Yes. Helpful? Not a bit. We just threw the ball back to the nursing home to figure out what to do. As one of our trainers likes to say “they are throwing away referrals for your agency” - however inadvertently, that’s what they are doing.

Next newsletter we are going to talk about some tips so that your nurses learn to capture those referrals. 

Budgeting Admissions: The Goal You’ve Got to Know! (part 2)
by

Last time we talked about how every hospice sets average daily census (ADC) goals, but most do not translate ADC into admissions. We talked about how the number of patients you admit (along with length of stay) are the key factors in reaching this goal, and how to calculate all of this. This time, we’re going to talk about how to prioritize reports and focusing on critical issues.

Prioritize reports: When creating the detailed logs and reporting forms necessary to manage your referral and admission process, don’t panic. “How am I ever going to track all this stuff” is a typical reaction.

Don’t be paralyzed by inaction: every data system is designed to meet the needs of many users, from the ones who need just the basics to those who wants a more sophisticated analysis. But just like you don’t use all the features of your word processing software, you dont need to track everything in your new system either. So don’t panic!

Focus on Measuring Critical Issues: the five measures that typically matter most in improving performance are the scheduled visit rate, the consent rate, call to visit response time, average visits/day, and the calls to admission rate. Start by focusing on these first, then add in the others.

Reason Codes Count: Now, get your staff in the habit of documenting why visits aren’t scheduled and consents aren’t signed. These “big two” can reveal critical needs in training. If you are getting back in inordinate amount of “family not ready”, that will also be an indicator of a possible need for training.

Budgeting Admissions: The Goal You’ve Got to Know! (part 1)
by

Every hospice sets average daily census (ADC) goals, but most do not translate ADC into admissions. But the number of patients you admit (along with length of stay) are the key factors in reaching this goal!

Calculate patient days by multiplying targeted ADC by the number of days in each month (or 365 for a year). For example, an ADC goal of 100 in July means 3100 patient days are needed this month to make the goal.

1. Determine a realistic average length of stay (ALOS): While the standards for admissions formula uses ALOS, if yours skewed due to a few longer outliers, adjust it to the level that you think is achievable. For example, we’ll target ALOS at 55 days.

2. Divide patient days by your targeted ALOS: In our example, we would divide 3100 patient days by an ALOS of 55, resulting in a July admissions target of 56.

3. Adjust for ALOS deadlines! Stay on top of your true ALOS as the month progresses. If your initial projection was 55 days, but it’s July 20th and your month to date ALOS is 50 days, you’ll need to adjust your admissions goal to 62 to meet budget. Make sure your team understands length of stay implications and remembers that EVERY DAY COUNTS!

Next time we’ll talk about prioritizing reports and creating detailed logs.

Online Referrals: A Help or a Hassle?
by

Ever order anything online? You select the items, you add them to the shopping cart, and then comes the dreaded “new customer” order form. How many times do you wish you could just wave a magic wand (or click a key) and all those empty name-address-credit card blanks would be filled in for you?

What’s in it for them? Many hospices have decided that their website can be used for something other than announcements, donations and service menus. That’s a good thing. What isn’t so good is when we decide to create interactive tools that make the customer do the work for us. First, we need to consider the reason we put up with the hassle factor when we order online:

~ It saves time. We don’t have to drive to the mall and wait in line at the checkout counter.

~ There’s more variety. We don’t have to go to another store to find the size we need or the style we want.

~ It’s private (hopefully). The clerk won’t snicker when you buy “What to Do if Your Life is a Mess.”

Time is prime: But do any of these reasons apply to our referral partners? There’s no advantage for them to order online unless it meets one of these needs. And the key need is saving time. It has to be easier than picking up the phone and reading a patient’s face sheet information to you. Well, that one is certainly a no-brainer.

Does it beat faxing? It has to be easier than throwing a face sheet in a fax machine. Many hospices have gone to a process in which the customer never has to pick up the phone. They just fax a face sheet and the hospice referral center confirms receipt of it within 10 minutes via a voicemail message to the referral source.

So here’s the real issue: In most cases, their software can’t talk to your software, so they can’t just attach something from their database. Instead, they have to fill in the blanks on your form, and we’re back to the hassle factor that all this was supposed to avoid. Does it mean we throw in the towel and stay stuck in a time warp? No! Here are some suggestions on how to make online referrals more user-friendly:

Limit the data demands. All you really need is:

~ Patient name
~ Family (or contact) name and phone number
~ Diagnosis (a dropdown menu may help)
~ Next step menu (see below)

Make it easy to transmit the referral information with as few fields as necessary. The more required answers, the more abandoned online referral forms.

Do not ask for any information that you can get from a faxed face sheet or a call to the family. That means no insurance information, social security number, birthdate, medications, history, etc. In fact, for hospital or nursing home referrals where you’re going to go anyway, no faxed information of any sort is needed. Get it from the chart when you get there!

Next step menu. This includes options such as “Call me before you do anything,” “I’m faxing a face sheet to you,” “Call the family today,” etc. You should also include an optional “Comments” section.

Test it with them first. Before you just post it on your website, talk to your key referral partners about what method works best for them. (They’ll never put e-mail first, because they’re in a time warp too.) But for those that use websites for medical information, as many do, have them look at a couple of your drafts and talk about what’s in it for them if they order online.

An easy update tool: When you receive an online referral, make that your ongoing communication tool. Just like when you order online, the website updates your shipping and delivery status. You can do the same for your referral partners

Hospital Liaisons: Will They Work For You? Part 4
by

Last three newsletters we talked about the importance of hospital liaisons, and how much potential for referrals and admissions they have, as well as tips on hiring. We’ll wrap up this week with productivity expectations:

Productivity Expectations: As with productivity goals for teams, much depends on base volume and geographic dispersion. If you’re even considering a liaison to process referrals onsite at facilities, then you should expect them to generate at least 2 referrals/day and facilitate 2 admissions/day, usually from a combination of 1-2 hospitals and/or a few core service area nursing homes.

Note: this is FACILITATING admissions (initial patient and family visit, consent paperwork, chart review, DME/physician orders) not completing the full admission (done by an admissions or primary nurse after transfer).

How to Get There: When they see the expectations, liaisons get defensive. Here’s what you’ll get:

The visit: “There’s no way! You don’t understand. It’s an hour with the family just on the visit alone, and you can’t predict this!”

Busy, busy!: “Finding the chart, filling in the demographics, faxing the information, calling in the DME, talking to the pharmacy takes forever!”

Make work: “I keep checking on the (referred but not discharged yet) patient every day because things could change, and besides, it gives me a reason to be on the unit”.

Visit management: An initial visit should last no more than 30 minutes. If it does, your liaison is not managing the discussion and they are exhausting the family. You have to set the expectation from the start of the visit that it will be only 30 minutes, and train your liaisons in proper visit management skills, the hold them accountable. This is one of the things we teach in our online Hospital Liaison course.

Clerical Work: Filling in demographic data on a form, faxing, copying, and calling in equipment orders are a waste of an expensive RNs time. While it’s our job to gather information and process the referral, who says it has to be a nurse? You’d be better off using a cheap program rep or referral coordinator for this while the RN Liaison spends her time problem solving with discharge planners (getting referrals), attending care conferences, and generating new business! It’s a classic mistake hospices make. They figure that the nurse is there anyway, so why shouldnt she do it all? (They make the same mistake in referral centers: using expensive RNs to do data entry, schedule admissions, and get insurance authorizations. You dont need an RN for any of that).

More Make Work: If your liaison is checking on the patient everyday and needs this as an excuse to be on a unit, you’ve got the wrong person doing the wrong thing. Instead of going back to see the patient again, they should be rounding on their top units and asking if there’s anyone we can help them with today. If they’ve made their daily paper route in one facility, they should go to the next one and do the same thing. “Make work” is rampant in hospice and home care liaisons, and you need to stop it. It gets to the point that some unit staff and discharge planners wonder “gee, don’t they have anything else to do?”. No wonder we come across as entitled and privileged.

GIP Case Management: If you average more than one patient in a GIP bed per facility, a care team case manager should be managing the patient, not the liaison. If you decide you want a liaison to do this, then lower the referral goal and don’t expect much growth in business. They’ll spend an eternity with the GIP patient and marketing will go to the end of the list.

Hospital Liaisons: Will They Work For You? Part 3
by

Last three newsletters we talked about the importance of hospital liaisons, and how much potential for referrals and admissions they have. Today we’re going to talk about tips on hiring, and we’ll wrap up next week with productivity expectations.

TIPS ON HIRING:

Look for flexibility: This is a job that requires good time management skills and the ability to juggle and prioritize multiple tasks.

Look for energy: This is not a job for someone who likes to spend time developing relationships with patients and families or who doesn’t have the sense of urgency thats critical to success in the admissions function.

Look for attitude: Your best bet is that this person will eat, sleep, and breathe admissions! You want someone who will get excited about building referrals 12% in 6 months and will do everything they can to exceed their target.

MORE ON HOSPITAL LIAISONS

What they do: Most hospices with a significant hospital base of referrals use liaisons to process new referrals, facilitate discharge and case manage GIP hospice patients at their contracted hospitals.

Marketing?: While they should have referral development (aka “marketing") as their primary focus, most are uncomfortable with it. So it falls in the “if they have time” category, which translates into the “I am way too busy to do that, so I’ll find something else to do instead” category.

LTC Facility Liaisons: While they’re usually responsible for marketing here too, many end up conducting countless in services which do little to grow referrals. Again, a large part of this is due to their (dis)comfort zone. They profess to “like” marketing, but deep down inside they want to be an admissions consultant and hospice educator.

Next time we’ll wrap up with a long section outlining the productivity expectations you should have on your hospital liaisons. If you have any questions about this column, or how our Hospital Liaison online course can help increase referrals and admissions, please email

Hospital Liaisons: Will They Work For You? Part 2
by

Last time, we talked about the importance of hospital liaisons, and what they do. This week we’re going to talk about how to find great talent when recruiting, and what skills they must have.

A TOUGH TALENT SEARCH - Finding the right person is the critical issue in implementing a liaison role. A major problem is that, while the nurse may have excellent assessment and caregiving skills, it doesnt meant she’s got the right stuff to:

Get the consent signed on the first visit, and do it in a timely manner

Build relationships with hospital and physician staff that increase referrals

Assist discharge planners with creative solutions to tough placement problems

The vast majority of hospices that use this model don’t have referral goals for the liaison, nor do they measure performance in terms of signed consents, admission processing time, and repeat visits to get the consent signed (or hopefully lack thereof). These are the critical indicators of admissions and marketing performance and must be emphasize to liaison candidates (as well as you current liaisons if you aren’t already).

MARKETING SKILLS A MUST

Most liaisons are nice nurses who are accommodating discharge planners and how can describe the hospice program well, but the marketing and referral development functions go straight to the bottom of their list and are done only when they are not busy with admission or care oversight issues. So don’t necessarily count on them to make a big change in facility referrals UNLESS YOU MAKE IT A POINT for them to focus on it, and train them on how to do it effectively. Our new online Hospital Liaison training does just that, and breaks up 4 hours of intense training into 15 mini modules to help the student take the course at their own pace and help them integrate, piece by piece, what is important in generating and processing referrals and admissions effectively and efficiently. If you are interested in the online course, Hospital Liaison Online Training.

Next week we’re going to talk about hiring tips, and all the different types of facilities you can effectively use a hospital liaison.

Hospital Liaisons: Will They Work For You? Part 1
by

There is a prevalent practice in many hospices of utilizing hospital liaisons. This position several functions in one. Just what is this hybrid role and will it work for your organization?

The liaison serves 3 functions in a hospital:

1. Marketing to discharge planners unit staff, and physicians.

2. Providing care oversight for general inpatient hospice patients in hospital beds

3. Consenting or, sometimes, admitting new patients

The concept can also be applied to a nursing home setting, except that the care coordination is typically done by a care team and the admission is for residents or patients being discharged from skilled care.

Hospital liaisons can be an excellent choice if you have engineered your process to maximize their effectiveness, have the right people in the position, and provide them with ongoing sales training. The most important single element identified by hospital discharge planners when selecting a hospice provider is quick service. Having the liaison positioned correctly will drive long term referral relationships. Make sure you have the right person and the right program in place.

Next time we’re going to talk about how to search for the right talent, what marketing skills are a must, and tips on hiring.

Got an IPU? Beware the Mecca Syndrome
by

Hospice inpatient units, either freestanding or in an existing care facility, are on the rise in many markets today. And most offer a very attractive alternative to other inpatient options, such as hospital floater beds or designated rooms in a nursing home.

Beauty can be a liability. However, our pride can get in the way of making sure we don’t oversell the unit. If we position it as too attractive, it becomes the premier place to be, resulting in delayed hospital discharges or disappointed families who thought they could just be admitted anytime.

We call this the “Mecca Syndrome,” in which the unit becomes the ultimate destination for patients and families at the end of life. And caring for the patient at home or in another setting can be perceived as second choice. To some, it’s almost a disappointment: “Well, I guess we’ll have to take him home (or keep him here) until we can get him admitted over there.”

Train (or retrain) your team. Oftentimes we have to undo the way the admissions team describes the IPU to patient and families. Talking about the beautiful wood floors, private rooms, garden views, and peaceful setting begins to sound like that dreamy trip to Bermuda. Their own home (or certainly the nursing home and hospital room) now feels second rate. Here are some tips to help manage the Mecca Syndrome for your hospice:

Don’t even bring up the IPU at admission unless the situation warrants it. If the patient is at home or in an assisted living facility, don’t mention it unless they are eligible for inpatient care or need assurance that there’s an inpatient option if needed later.

Reposition the unit. Here’s a better way to talk about the IPU: “Hopefully, your dad will be able to be cared for at home (or stay right here in the nursing home). That’s what most patients and families want. If he needs a level of care that can’t be provided at home, we have a care facility. But we’ll try to do everything possible to keep him here so that he doesn’t have to move anymore.”

Train (or retrain) discharge planners. It’s so much easier for a discharge planner at the hospital to tell the family that they can just go to the IPU than it is to work out alternative discharge plans. That doesn’t make them bad; it just makes their job easier.

Here are some tips to help with professionals:

1) IPU = referral call. Tell them that every time they think “IPU” to just call us instead and we’ll handle it from there. Will this work? Probably not, but it’s a start in the right direction.

2) If they call to ask if you have a bed, don’t say yes or no or that you’ll check to see. Instead, ask them about the patient and the situation first. Then, regardless of what they describe, tell them that you’ll meet with the family right away so that if they are eligible and a bed is (or becomes) available, everything will be ready to go.

3) Save the brochure. Don’t automatically include that lovely IPU brochure in all of your admission packets. But be sure to tell admission team members to carry it separately and offer it only as appropriate.

Asking For The Referral at Every Single Visit!
by

In order to increase referrals, you need to increase “top of mind” awareness among your referral sources. After all, they dont just sit around all day, twiddling their thumbs and thinking “who can I refer to hospice today?”

You need to ask. In order to have that consistent awareness by your referral sources, you need to ask the question at the end of every admission visit: “is there anyone else I can help you with today?”

It’s not automatic: as always, you’ve got to role play this with your teams so that it becomes and natural way to end a visit. The more they practice, the more it becomes second nature. The more it becomes second nature, the more you ensure that it happens on every. single. call.

For the Care Teams: This applies to them also. At the end of every facility visit, they need to ask the staff is there’s anyone else who they can help them with today.

Should be natural: Teach and practice having the team members ask in a manner that is consistent with their personality, sounds natural, and doesn’t make them feel slimy. The key is to make it easy for the staff member to try it out. Once they do, they will see success and will start to include it in more and more calls. Keeping it natural makes it easier to get them to their first attempt.

Online Inquiries: Available Anytime from Anywhere
by

More consumers are seeking medical information online than any other medium. This is very true for hospice. The adult child faced with a dying loved one and often living in another part of the country is looking for information and assurance.

Data tell us that the most common time of day for these consumer hits to your website is late at night. People cant sleep and are looking for answers. The keys to making it easy for a consumer to make an inquiry are:

- Make it simple to ask a question

- Provide Easy to access information about hospice with the invitation to get personal questions answered interspersed.

- Offer something of perceived value, a report or other tool to encourage the consumer to make contact

- Reassure the consumer that your hospice is the best choice for their needs.

Stress ability to effectively communicate with long distance family and friends. Consider online resources such as support groups or bereavement programs.

“Customers" Rule!
by

Call patients “customers”: Why not call patients what they are? While your team may think “customer” is too commercial, consumers often times view “patients” like they do “policyholder” or “passenger”. Just another way to avoid elevating them to the status they deserve: customer.

If you want to send a message of change, there’s no better way than changing your vocabulary!

Call them Guests: Want to really go out on a limb? A nursing home recently started calling it’s residents “guests”! Consider that for your IN-PATIENT and residential “guests”!

Remeber, they are not “Our Patients”: When dealing with physicians, train your staff to refer to patients as “their patient”. The physician does not view the hospice referring to them as “our patient” when, in fact, they referred them to us.

They are “residents”: Skilled, Assisted, and Independent living facilities refer to “residents” and do not think in terms of “patients”. Your staff should be trained to talk in terms of “their resident” when talking about a patient with a facility staff member.

Remember, every little detail counts when we’re trying to build rapport with our referral sources. . 

Asking the Big One: “How did you hear about us?”
by

Why is it that this most crucial question in assessing your community marketing efforts is not asked nor discerned in 87% of consumer calls that aren’t referred by a physician? It’s because your staff is so busy talking to the caller (as opposed to listening to them) that they forget. In addition, they’re reluctant to ask because “it sounds like a sales person.”

If only they’d listen: If your call staff would focus on engaging the caller in a “tell me what’s happening” conversation, they wouldn’t have to ask most of the time because the “how they heard about us” part would be revealed within the story. But they’re usually so busy telling the caller about the program and all the hoops they have go go through just to be visited that the last thing they’re concerned with is how someone happened to call us today.

So here are some helpful tips:

~ Engage the caller: You have two ears and one mouth: Please use them in that proportion! Before you launch into a “wehave-itis” (we have nurses, aides, social workers") or “youhavetohave-itis” ("you have to have a terminal illness, less than 6 months, a doctor’s order, blah, blah"), say to the caller, “Sure, I’ll be happy to help you. Talk to me a little about what’s going on.” Ninety percent of the time, the caller will end up telling you how they heard about you. ("My friend Betty said her sister was in your program”, or “the nursing home said you go in there to help people”, or “I remember reading that article in the paper last month’).

~ If they don’t say how they got your name, wait until they’re finished and then say, “Well, I’m glad you called us. And how did you happen to hear about us?” If you engage the caller first, this doesn’t come across as a “sales” question. It’s asked out of curiosity and as a natural part of the conversation.

~ What call staff fear most is that they’ll sound like a telemarketer asking for a coupon code—and they will if they ask the question up front before they express any interest in the caller’s situation.

~ The irony: Many do sound like telemarketers because they start asking all the insurance and demographic information up front without having first shown any interest in the caller’s situation or reason for calling. And what’s worse, they’re clueless as to how insensitive they can sound in the process.

~ If you want answers, let them talk: Even if they “just want information” about your program, they have a reason for calling, and that’s what you must discern before launching into program details or asking the “how did you hear about us?” question.

Track all calls from all channels. There is absolutely no wrong answer to how the caller heard about your hospice program. As much information that can be trapped, should be recorded. Once you have a good database of this information you will be able to see what is and what is not paying dividends. You will be able to track back where you are getting your best and worst patients from. This is VERY important when dealing with “sister” organizations or other parts of your health care system. Knowing which of the professionals in the organization are most bought into hospice and particularly those who strongly advocate for YOUR hospice is very valuable. You can follow-up with them and reinforce positive behavior.

Want to Beat Your Competition?: Make the Big Change!
Part 2
by

Last time we talked about the need to change the focus of your Referral Management System (RMS) in order to maximize your potential. We talked about the agencies that implemented our Simione Referral Management System (S-RMS) in home care and hospices agencies saw tremendous growth, and how one of the paradigm shifts was in approaching every call as needing a visit until proven otherwise. This time, we’re going to talk about how to take the big step, what can happen, and how to make that transition smooth.

IF THE BULLETS START TO FLY: Beware. Unless the rest of the clinical staff is on board (and this take awhile), be prepared for a mutiny. While they say they accept the change, some may actively revolt. Make sure to gather your clinical team together to talk about the upcoming change, and how it will affect them and the agency. Make sure they know how important it is to the agency, and to the community.

SO HOW TO MINIMIZE THE IMPACT? Here are a few tips that can really help in the transition to a new service center model:

-Move it out of Clinical Territory - create a “no fly zone” around the referral center by moving it away from the clinical team offices. Locate it near the NON-clinical offices (or better yet, next door to marketing).

-Putting it next to marketing also helps send the message that it’s not a clinical function. In fact, it’s functionality closer to marketing than anything else, so why not put it where it belongs?

MANAGE IT “MANAGER TO MANAGER”: Restrict the clinical staff from marching in to ask the customer service reps for clinical information (a sure fire way for them to express their clinical supervisor).  Keep it managed “manager to manager”.

Next time we’re going to go over more tips for the referral center and how to maximize efficiency.

Want to Beat Your Competition?: Make the Big Change!
Part 1
by

If you’re like 99% of agencies out there, every day your competition keeps growing. To fight that, across the country we’ve been called in to implement our Simione Referral Management System (S-RMS) in home care and hospices agencies. It didn’t matter what type of territory it was, or whether the agency was big, small, or “just right”, the results our clients experienced were astonishing (we’re working on a Special Report on Referral Management Systems now that will blow your mind). The data we’ve collected from our clients was very interesting, and showed that they went from lagging behind to beating the competition in the span of 6-12 months. 

While many changes, big and small, helped bring about bigger numbers and greater growth, the one big change that made a difference was changing the intake/referral center function from an “order taking process” to a true customer service oriented experience. Professional referral sources, community callers, and patients and families all were blown away by the difference, and it resulted in greater referrals, admissions, and customer service scores.

So let’s say you’ve decided to make the change. You are going to change the way you manage your referrals (your RMS). The first step is having CUSTOMER SERVICE representatives answering the phones in your intake/referral center - not clinicians - but true professionals with a customer service background.

CHANGE ISN’T EASY - and it’s particularly challenging for traditional hospices. For a long time it was thought that only a nurse or social worker could handle a referral. That’s because we were in the ORDER TAKING and SCREENING business, not in the service business.

Once you decide to take the leap and embrace the concept of “every caller gets a visit (until proven otherwise)”, the you realize the goal of the referral coordinator is to facilitate a visit with the referred patients and families, or with callers requesting information, and NOT to screen for “hospice appropriateness”. With the need to manage you costs at all levels, it doesn’t make sense to have a nurse answering phones when the true nursing function occurs at a visit. What does make sense is to have someone who can move reluctant families to accept a visit by focusing on THEIR concerns and not OURS.

In the next part, we’re going to talk about how to take that step, what can happen, and how to make that transition smooth.

You Snooze You Lose: See the Referral Today!
Part 2
by

Last time we talked about why it’s important to see a referral the same day. Remember the U.R.G.E.N.T. motto we discussed several weeks ago. Today we’re going to delve in deeper.

If you haven’t seen the patient yet, the referral source might suggest the liaison drop in and give the patient a brochure “just in case”. It happens a lot, and all of a sudden you’ll be on the losing end if you havent already scheduled it and are stuck with no one to send. So get ahead of the curve, and make your process a same day visit.

If you had shown up on the same day, it may have deterred the discharge planner from suggesting that home care see the patient, or another hospice walking into their office and offering to “drop off that brochure” for them. And even if home care did drop by, your visit would hopefully have convinced the patient that hospice is the best solution.

SKILLED CARE - The same is true with skilled care rehab facilities. More nursing homes today are actively going to the hospital and meeting with the discharge planners, patients, and families - and so your competition grows.

THE HOSPITAL - While the discharge planner may not have sounded urgent, they always are. Good DCPs want to get things tied up as soon as possible, so getting hospice consents and transfer plans in place before the day of discharge is one more thing off their to do list.

THE PHYSICIAN - Let’s not forget the physician in all of this. The heat is on them to get the patient out of the hospital. You may be able to facilitate an earlier discharge by reassuring the family that they can handle this at home and getting a good care plan ready NOW.

Those are just among the many reasons why putting the U.R.G.E.N.T. process into place at your hospice agency, and seeing the hospital referral the same day will be the key to keeping and growing your admissions.

You Snooze You Lose: See the Referral Today!
Part 1
by

So you get the call from the hospital and the discharge planner says that the patient is scheduled for discharge in a couple of days. Since she doesn’t express urgency, and it’s 3 in the afternoon, you decide it’s okay to schedule the visit for tomorrow or the next day. WRONG! Why? Just because the referral source isn’t urgent doesn’t mean you don’t have to be! Here’s a few reasons why:

1. “Same Dollar Competition”: As patients and families become more informed about post acute options and benefits, it not only helps hospice, but everyone else competing for the same medicare dollar, including HOME CARE and SKILLED CARE in Nursing Homes.

2. Home Care: Here’s the scenario: a good home care liaison is always talking to discharge planners and physicians about recommending home care as an option if patients aren’t comfortable going home with hospice. And if you think about it, who is? Most patients (and some referral sources) don’t really understand the benefits of hospice, at least not until they experience it for themselves. So to them, home care isn’t all that different - so why not? Don’t give them the chance - always remember the patient needs hospice for a reason.

Next time we’re going to get into this a little deeper, but for now, remember that everything is urgent.

It’s Time to Get U.R.G.E.N.T.
Part 2
by

Last time we talked about how acronyms really work to help staff with the processes you put in place, and in particular how vital a sense of urgency is to everything they do. We discussed the U, R, and G in the acronym, and this week we’re going to finish it up with E, N, T (no relation to the specialty of medicine).

E. Essentials - What are the essentials that we need to schedule a visit? Name, address, and phone number. That’s it!

N. Next Step - Tell them what happens next. But first, ask their permission to contact the physician and/or facility to inform them of the request for help with hospice care. Then the next step is to schedule a visit today from the hospice representative.

T,. Thank you - Last, but certainly not least, THANK THEM FOR CALLING YOU TODAY. We think we always do this, but you’d be surprised what our mystery call program uncovers is actually said, and you’d definitely be surprised by how often this critical step is missed.

If you’re interested in learning more about our mystery call program and how it can increase your referral to admission rates, email

It’s Time to Get U.R.G.E.N.T.
Part 1
by

Acronyms work! They can help us remember an important process or message. For hospices, “U.R.G.E.N.T” sends a powerful message to your team that a sense of urgency on their part is key in getting patients and families the help they need in a timely way.

U. Understand: “I understand how you must feel” or “I understand what a difficult time this must be for you”. When we tell callers or families that we UNDERSTAND their situation, it shows that we emphasize with them, and empathy is a key factor in gaining trust.

R. Reassure: “I want to reassure you that you did the right thing by calling us today”. Why is this so important? Research shows that when families call, they often feel guilty because they have “given up”. Even though we reassure them that there is always hope and the we will treat the patient aggressively for comfort care, families often struggle with having to take this step. So it’s important to tell them that calling us was the right thing to do for their loved one.

G. Get Help: Research also shows that just picking up the phone to make the call is a first step that many families feel is “enough for today”. However, we know that getting help today is what makes hospice so much better. So it’s our job to remind them that they called because they need us, and it’s important they get our help TODAY. 

We’ll go over the rest of the acronym next time.

Make A Good First Impression!: Admissions Packets
Part 2
by

Last time we talked about how making a good impression is paramount when going on admission visits, and one of the keys to making a good first impression is not burdening patients and families with huge admissions packets. We talked about the first two steps to the Great De-clutter, we’re going to finish up with the last two steps:

STEP #3: MAKE FORMS CONSISTENT - Now Clean Them Up

- Crummy “copies of copies” look tacky, so if you’re going to use a copier to form duplication, KEEP THE ORIGINAL IN A PLASTIC SHEATH so that it’s clean next time.

- CLEAN THE IMAGING SURFACE OF THE COPIER so that you dont have those awful black dots all over the page!

- Make a test copy before you run off 200 copies to BE SURE THE ORIGINAL IS ALIGNED STRAIGHT on the page!

- You should never have a copy that is more than a first generation copy. YOU DO NOT NEED NCR FORMS with a peel off copy attached. Just make sure that an unsigned copy of the form is given to the patient.

TIP: Many times, depending on your printer company, having fresh copies printed can be one or two cents cheaper than using your own copier, copier ink, and paper to make copies of your forms. Considering how much paper we use, this could be a considerable savings over the years - so do your research into which is cheaper. 

STEP #4: UNIFORMITY

-Make sure all fonts are the same
-Make sure your logo is on every page
-Make sure your margins are the same
-Make sure every footer has the page numbers and your agency name

Make A Good First Impression!: Admissions Packets
Part 1
by

Take a look at your admissions packet. The folder is bulging with pamphlets, fact sheets, and forms, all with a mishmash of logos, fonts, and layouts. It’s a MESS.

STEP 1: Sort the information - You know the drill: some surveyor made a comment about some missing information six years ago, and now it’s evolved into a form that’s sacred for no good reason. First, take all your admissions forms and sort the information into categories: program, insurance, privacy/records, consent, basic demographics, rights/responsibilities, etc.

STEP 2: Streamline your repetitions - Your goal is to eliminate all repeated and redundant information.

- Enter all the basic demographics on a face sheet, the remove all but the patient name and record # from every other form the patient/POA signs. If it doesn’t have to be signed, it doesnt need a name on it! And remember that every page of a signed document should have the name and record #.

- Try to combine forms that require signatures so that the family only has to sign one page. You can use a small font, which is okay on documents that are rarely read anyway. Use bold headers that indicate what the paragraph is about so that your nurse can more easily guide the family through the document.

Steps 3 and 4 will be covered in the next edition.

Visit Scheduling: Getting Field Staff On Board
Part 2
by

Solution #1: Get their input: Meet with the Field Nurses and ask them how they would prefer to have their day structured. But, make it clear that an average of 3 admissions visits per nurse per day is non-negotiable (the truth is, if they start a visit directly from home, that alone increases their capacity).

Solution #2: Get them fax machines: if they dont have secure email to attach supporting clinical info to the admitting nurse, then put fax machines in their homes. You need to give them the processes and tools to stay out of the office in order to increase admissions capacity.

Those are just a couple solutions to how you get your visit schedule under control and into the hands of the referral center where it belongs.



Visit Scheduling: Getting Field Staff On Board
Part 1
by

Here’s a test: who controls visit scheduling at your hospice? Nine times out of ten it’s the nurses in the field who are in charge. They dictate their availability and get a little testy with the referral staff if a visit is scheduled outside their comfort zone or time frame.

MYTH #1: Families don’t want to schedule admissions before 10am: Why does nearly every hospice schedule put their first admission visit at 10 or 10:30? Because nurses are used to doing two admissions a day, so the 10am/2pm time slots have become the accepted (and preferred) norm. BUT IT DOESN’T HAVE TO BE THAT WAY. If you tell a family that the nurse will be there at 8am, they’re usually fine with that. They want help as soon as they can get it - they are the ones suffering, after all. We are the ones who create barriers, not the families.

MYTH #2: It’s the paperwork that slows everything down: True, hospice admission papers and assessments take a lot of time. But the key to successful visit scheduling is employing good time management practices. For instance, dont have the families recite their medications during the visit - tell the family to have them written down and ready for when the nurse arrives.

Next week we will go over some solutions to the problems you face in getting more than two admissions visits out of your nurses.

Stop Your Team From Giving Away The Farm!
Part 2
by

Here are a few re-training ideas for your Program Reps, Liaisons, and Admissions Nurses:

-DESCRIBING THE BENEFIT - It’s okay to define team roles, but indicate that “the extent of their role will depend upon your needs and further discussion with the care team”. Don’t specify standard visit frequency or length, except when putting together the initial plan of care. Then indicate what it will be for the next few days only.

-DESCRIBING THE PROCESS - It is absolutely appropriate to indicate that the interface with different team members will be adjusted as the needs of the patient or family change.

-REMEMBER VOLUNTEERS? - It’s a tough situation when the family says, “well, he needs a lot of help,” or, “They said you’d be here everyday.” So, if they don’t have the resources for private care, and they need some additional help, tap into your volunteer pool! But again, don’t make any promises!

-REMEMBER PRIVATE DUTY AIDES? - If they do have the resources, recommend private duty help. A caveat: the labor shortage is a big problem here too, so offer the resource, but don’t promise the outcome!

Stop Your Team From Giving Away The Farm!
Part 1
by

“Do you have any idea what they’re saying out there?”. This always seems to be the first thing we say to clients after observing admission visits. It’s not that they aren’t trying to do a good job. It’s that we’ve trained them to describe a standard hospice benefit that may not be appropriate for the patient’s or family’s situation.

Dangerous expectations: If your nurses or reps are telling families that “the nurse visits 3-5 times a week, and the aide will be here for an hour and a half”, then they are setting expectations that may not apply.

Remember case management?: What if the patient only needs a visit every 2 weeks and has a network of family and friends who want to help him with daily needs? Should we be offering a level of care to this patient that may prevent us from providing more intensive care needs to an acutely ill patient with no caregiver?

Good News, Bad News: The good news is that hospice use will continue to grow. The bad news is that reimbursement will remain tight, as will the labor pool. So it’s up to us to increase care team capacity by making sure we work smarter, plan smarter, and don’t set inappropriate patient expectations!

Next week we will go over my top 4 tips for how to do just that.

Great Service is Infectious and Fun
by

Think of how much fun it is when things are working smoothly and everyone is happy. Now, stop and think about how that happened. If you can replicate that scenario on an ongoing basis, you are well on your way. However, if it is hard to remember the last time your agency felt like this or it happens for only fleeting moments, then you might want to rethink key strategies and focus systematically on your customer service profile. Your investment in building the best customer service will pay tremendous and long lasting dividends. This will translate into everything from greater profitability to more personal satisfaction, as well as many other tangible and intangible benefits.

Just ask yourself, “Do I look forward to coming into work every day?” “Does the rest of the staff?” This will give you a good sense of the areas that need improvement. It will also draw to the surface the rewards that await you with the successful implementation of your customer service program. If you want to have more fun, retain your current staff, and embrace rather than turn over your referral partners, the answer lies in the successful implementation of your customer service program.

Why strive for incredibly great service instead of just good service? What is wrong with good service? Primarily, the delivery of good service is not enough to differentiate you from your competition. Do you know of other hospices that provide good service? If you want to build solid customer relationships, you need to deliver superb service. If you want to inspire your staff, you must strive for excellence. People expect good service. However, they are WOWED by excellence. There is a buzz that surrounds incredible service organizations. People just want to be associated with them.

Has the Patient Been Told? Dealing with Your Fear
by

We hear it all the time: “what if the patient (family) hasnt been told? The doctor orders hospice, but he hasnt talked to them and then we have to deliver the bad news”.

Our Fear Factor: So we end up going into the patient’s room and go through this endless visit that begins with “so what has the doctor told you?”…..

So, what’s wrong with that?

Well, first off, it makes us look uninformed and uncomfortable.

It makes the doctor look like he’s not doing his job (patients wonder: why are you asking me?).

And it can open a long medical history discussion, most of which you don’t need to know.

It’s your fear and discomfort that drive the question! As a professional, you should be focusing on the discharge and care plan needs, not on protecting your own comfort zone. It’s also a “spooky” question, and it only adds to the impression that hospice is all about doom and gloom. Next time, we’ll go over what to say if they haven’t heard about hospice from the doctor.

Pens for Patients And Teams Too!
by

Will you please start equipping your admissions team with logo laden pens so that they can give one to each customer, patient, and family that they visit? This will build name recognition and provide the phone number (make sure to put the phone number you want them to use on the pens - the customer service center). Not only will it build name recognition, but when you make the phone number handy for patients experiencing distress, they are more likely to call you before 911, which is one of our industry’s struggles.

As well, ‘passing the pen’ is one of the clumsiest games that hospices play during consent and admission. The family will need to sign forms, so why not just give them a pen to use (and keep)? Besides, sharing that handheld pen can spell trouble during flu season!

TIP: Make sure the pens your team uses have your logo too!

Know Your Numbers
by

The most vital component to success in today’s home care and hospice industry is making sure your financial team and sales team are working closely together.  There is no room for error when it comes to delivering the number of new patient admissions you need to fuel your agency’s mission. 

Too few admissions can create havoc in the budgeting, staffing, and scheduling process. When the sales team can deliver a steady increase in the number of admissions, and your financial team steps it up in tandem, your entire agency will run smoothly, efficiently, and with a bigger bottom line.

The sales team must be managed and trained to insure that they are operating with maximum effectiveness and efficiency. While an agency’s greatest need is to deliver more admissions per sales person, this can only be accomplished by having the most professional sales team possible.  One way in which an agency greatly benefits from such a sales team is when they are trained to provide information to the financial team that can measure and track the cost of acquisition for new cases. This helps determine the return on investment for the sales and marketing program, which is one of the most important and overlooked aspects of sales and marketing success. 

Metrics related to sales, such as benchmarked data, is improving and will be an ever more important element for management of the organization. Other important data elements that should be measured and monitored include market share, referral concentration, trended admissions by referral partner, and hospital discharge patterns.  Each year better data becomes available, and organizations need to know how they stack up.  An executive dashboard can be developed to keep all of the management team focused on these elements.

We have discussed the importance of the sales team delivering on their budgeted admissions, what can finance do for the sales team? 

First and foremost, make sure sales representatives are paid on a timely basis.  Their salary, incentives, and expense reimbursement should be a high priority.  In any industry, one of the worst disincentives for sales people is to mess with their cash.  Incentive plans should be crafted to be easy to understand, directly tied to performance, and as immediate as possible.  Expense policies should be set up to make it easy for the sales person to comply, and with quick turnaround on the payments.

There should be a clear understanding of the organization’s policies and procedures related to expenses for sales and marketing purposes.  Finance should be a part of the orientation of every new sales person.  The better they understand, the better they will comply.  Start with the organization’s philosophy regarding these expenditures, and then the rules and regulations.  Policies should be reviewed frequently by legal counsel to insure corporate compliance.  Compliance is an extremely important element and is another area where the two departments need to have a close, synergistic working relationship.

With finance and sales on the same team, success is certain to follow.  Both must support each other, and in doing so they will provide the rest of the organization what is most important: providing extraordinary care to the patients served.

Is Your “Bridge” Program a Detour?
by

Many hospices offer bridge programs that provide palliative care and support services to patients (and their families) facing serious illness. These patients either don’t meet the hospice guidelines or meet the hospice guidelines but aren’t ready to choose hospice yet.

It’s this latter group where we’re seeing a lot of growth, and its cause for concern. There’s no question that bridge programs are beneficial and fill a gap between curative treatment and hospice care. But they also run the risk of becoming a “default hospice” in which admission teams can too easily use the bridge program as a way to avoid actively advocating the hospice choice.

The Detour Dilemma - ‘Not ready yet’ is the number 1 reason for pendings and non-admits. While many hospice patients and families arent ready for hospice care, its our job to help them take the first step by convincing them to try hospice services, even if just for a few days. Once they try it and realize the significant (and nonthreatening) benefits hospice care offers, few revoke. But getting them to the timely point of choosing hospice is whats important. The ease of detouring to bridge program often becomes and “out” for admissions staff that either lack the training or the skill set to move the patient to selecting hospice care.

The fear of advocacy - With all the passion that hospice staff bring to the table, you’d think that being an advocate for hospice care would be easy. But it’s a huge leap from offering choice to advocating hospice. While its true that patients may need time to process the seriousness of their illness, all too often the “process” last until a few days before they die, and they never receive the true benefit of hospice care.

The hospice programs that truly excel at quality care are those that help resistant patients try hospice care “for just a few days”.

Here’s a tip that really helps - tell patients: “While you’re thinking about it, try us for a few days. The benefit is free, so you might as well take advantage of it. And this way, you will at least be covered at night if you should need anything.”

Next time we’re going to go over the impact of doing this, as well as Eligible and Ineligible patients, and a breakdown of how much of a difference on your bottom line this can be.

When Your Nursing Home Team Gets a Referral
by

You may have your liaisons or marketing reps covering the nursing homes and providing in services there, but who usually gets the referral? Your care team. They are the ones who are there day in and day out, and the ones most readily approached by the staff.

Have you trained your care teams? Do they even know it is a referral? Any question about criteria or appropriateness, or a tap on the shoulder with, “I may have one for you but the family is being difficult” is a referral! Why do you think they are asking the question? Because they’re just curious or have nothing better to do?

They are asking because they need your help! They may not use the term ‘referral” or “help” directly, but that is exactly what they are doing. So it is the care team member’s job to take the referral.

What usually happens is that your staff politely says “well, we’re always here to help, so just let us know”. Nice? Yes? Helpful? Not a bit. We just threw the ball back to the nursing home to figure out what to do.

1. Ask about the situation: There’s always a story there, so get the nursing home nurse or social worker to talk about the patient and family.

2. Ask the name of the patient: if they say that they want to talk to the doctor or family first, tell them that you won’t do anything other than give it to your referral center so that it is on their radar screen when the nursing home is ready for us to meet the family.

3. Offer to look at the chart: If they are asking about criteria. This is not trolling for patients! They made a comment to you or asked about a situation. That means they have someone in mind and are asking for your help. That is a referral, and it is absolutely the right thing to look at the chart and talk to the staff about their perceptions of the patient’s health status.

If they give you the name of the patient or allow you to look at the chart, call the referral center with the patient’s name so they get it on the ‘pending’ status. Never tell the nursing home staff to just call it into your referral coordinator when they are ready and that the referral team will take care of it. You need to make it absolutely effortless for the nursing home staff to make a referral, and it starts with making the call yourself.

Asking For The Referral at Every Single Visit!
by

In order to increase referrals, you need to increase “top of mind” awareness among your referral sources. After all, they dont just sit around all day, twiddling their thu